Teeth in the maxillary sinus--imaging and management

Ectopic Upper Third Molar in Maxillary Sinus: A Case Report and Literature Review

Ectopic tooth in maxillary sinus is a rare entity. There are many causes of this condition include developmental disturbance, pathological process, iatrogenic, and in some cases there is no identified cause. The ectopic tooth could be asymptomatic or presented with various symptoms depends on its location. A 19-years-old woman presented with left-sided facial pain and slight swelling at the site of the upper 3rd molar tooth for three months. She gave a history of mid-facial trauma with an operation in this area, 11 years ago. Orthopantography and computerized tomography confirm the diagnosis of ectopic tooth within the maxillary sinus. The tooth was removed by Caldwell-Luc procedure. The patient was remained free of the presenting symptoms at three months follow-up. Reporting any case of an ectopic tooth deserves the ability to know the various aspects of this condition. We reported a further case of ectopic 3rd molar tooth in the left maxillary sinus, most probably, due to previous mid-facial trauma or the surgery in this area.

Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature

Background: The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic. Case presentation: A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla. Review Methods: An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up. Results: A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases. Conclusion: The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.

Bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst identified with ophthalmic, nasal and maxillary complication: A rare case report

Etopic tooth eruption is the occurrence of the tooth germ in a nonanatomical position. It can be associated with dentigerous cyst, which is the second most seen in the development of odontogenic cyst commonly presented in mandibular region and seen in single form. It is usually accompanied with mandibular third molar followed by canine. Bilateral and multiple dentigerous cysts in nonsyndromic patients are fairly rare phenomenon and barely documented in the literatüre. We report a rare case of bilateral dentigerous cysts associated with ectopic third molars in the maxillary sinuses. Computerized tomography scan confirmed the diagnosis. A 32-year-old female patient manifesting as postnasal discharge accompanied with chief complaint of nasal obstruction, pain at blinking right eye from pressure of cyst at the inferior orbital rim, and headache for the last 1 year. This report presented our management of rarely seen case of bilateral dentigerous cysts related with ectopic third molars in maxillary sinuses. Ectopic teeth eruption in maxillary sinus should be treated as early as possible once it is diagnosed, in consideration of related complication of orbital and nasal involvement. The symptoms totally recovered with the suitable management method for our patient. The prevalence of maxillary third molars ectopic eruption in the maxillary sinus (Antrum of Highmore) is extremely rare in the literature. Lack of treatment protocol for such ectopic eruptions in the maxillary sinus and its rareness deserved to be added to the literature.

Ectopic Tooth in Mandibular Canal, Maxillary Sinus, and Mandibular Condyle

Eruption of tooth into place other than tooth-bearing region is defined as ectopic eruption. Although ectopic eruption of tooth is rare, there have been cases in the maxillary sinus, mandibular condyle, nasal cavity, chin, palate, and orbital floor. Due to ectopic teeth's rarity and lack of consensus for ıts treatment, incidence was entitled to be added to literature and discussed. It was reported that odontogenic tumors and cysts can develop around the ectopic tooth. Thus, ectopic teeth can be followed up regularly in case of no signs and symptoms. If the patient has unusual orofacial pain, undiagnosed nasal discharge, maxillary sinusitis, preauricular pain, preauricular fistula, trismus, and lip paresthesia, the patient should be evaluated in terms of ectopic tooth. Whether the patient has signs and symptoms related to ectopic tooth, early intervention for the removal of ectopic tooth along with accompanying lesion is the treatment of choice. Specialists choose intervention way based on their experience. When selecting the intervention, minimally invasive and less morbid way should be preferred. Intraoral approach rather than extraorally should be the first choice to prevent unesthetic scar and damage to facial nerve.

Ectopic tooth in maxillary sinus compressing the nasolacrimal canal: A case report

RATIONALE

Ectopic tooth is tooth erupting out of normal anatomical position. Ectopic tooth can occur in different positions, such as maxillary sinus and nasal cavity. In this article, we present a rare case of an ectopic tooth with a dentigerous cyst in the maxillary sinus compressing the nasolacrimal canal.

PATIENT CONCERNS

An 8-year-old girl presented with a 2-month history of spontaneous lacrimation in her right eye. When she wept, more tear shed from her right eye than that from the left one. Computed tomographic (CT) imaging showed a huge low-density image containing a tooth in the maxillary sinus in her right maxilla; the right nasolacrimal canal vanished due to the compression of the ectopic tooth.

DIAGNOSES

Ectopic tooth with dentigerous cyst of right maxilla, and obstruction of nasolacrimal duct.

INTERVENTIONS

The patient underwent nasal endoscopic maxillary sinus cystectomy.

OUTCOMES

The patient recovered well after cystectomy and has been symptom-free.

LESSONS

The unique finding is that this is the first report about ectopic tooth compressing the nasolacrimal canal and inducing spontaneous lacrimation. Treatment: aspect: surgery under endoscope is a minimally invasive approach to ectopic tooth.

Ectopic maxillary tooth as a cause of recurrent maxillary sinusitis: a case report and review of the literature

This article presents a rare case report of an ectopic third molar tooth located in the medial wall of maxillary sinus in a young male manifesting as recurrent sinusitis along with upper jaw pain and postnasal discharge diagnosed with an ectopic tooth and bilateral dentigerous cysts. This article aims to discuss this rare presentation of an ectopic tooth as a cause of recurrent maxillary sinusitis and the endonasal endoscopic management of the case.

Case Report: Ectopic third molar in the maxillary sinus with infected dentigerous cyst assessed by cone beam CT

Ectopic development of teeth in nondental areas is uncommon, especially in the maxillary sinus. A panoramic radiograph is the routine diagnostic radiographic examination performed for this type of eruption, although cone beam computed tomography (CBCT) is highly recommended for further localization of the ectopic tooth and assessment of the characteristics of any associated lesion before a surgical procedure. We report a case of a 13-year-old female student who presented with purulent discharge posterior to the upper right second molar with a bad taste and foul odour. Radiographic examination revealed a maxillary third molar tooth located at the posterosuperior aspect of the right maxillary sinus with a hyperdense lesion surrounding the crown, obliterating the sinus cavity. Both the tooth and dentigerous cyst were surgically removed under general anaesthesia through Caldwell-Luc antrostomy. After a three-month follow-up, the patient was symptom free and had an uneventful recovery. The rare and critical location of the reported third molar along with the infected dentigerous cyst indicates its complete enucleation to avoid complications as recurrence or malignant transformation.

Bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst-A rare case report

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Bilateral ectopic eruptions of maxillary third molars in Antrum of Highmore (Maxillary sinus) are rarely seen and scantly documented in the literature.

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Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature & discussed.

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An unusual case of bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst, and impacted mandibular third molars.

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Ectopic teeth are commonly observed in the second or third decade of life. The age range varies from 4 to 57 with a mean age of 28.06 years.

Introduction

Ectopic eruptions of a tooth in a non-dentate region is a rare entity and such cases have been reported to occur in the nasal cavity, orbital floor, maxillary sinus, mandibular condyle, chin, palate and coronoid process.

Case presentation

We report a case of bilateral ectopic eruption of maxillary third molars associated dentigerous cyst. A 27 years old female patient reported to us with chief complaint of purulent discharge form nose and recurrent facial swelling for last 2 years. Complete removal of cystic lining and extraction of ectopic maxillary third molars along with mandibular third molars was carried out.

Results

Post-operative healing was uneventful.

Discussion

Bilateral ectopic eruptions of maxillary third molars in Antrum of Highmore (Maxillary sinus) are rarely seen and scantly documented in the literature. Dental ectopia may occur in antrum and present with local sino-nasal symptoms attributed to chronic sinusitis. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature & discussed.

Bilateral dentigerous cysts and ectopic teeth in the maxillary sinuses: A case report and literature review

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Dentigerous cysts are commonly single lesions. Bilateral and multiple dentigerous cysts are very rare.

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Ectopic tooth eruption outside the oral cavity is a rare entity.

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The endonasal endoscopic approach has the advantages of avoiding external mucosal incision, oroantral fistula formation and recurrent sinusitis.

Introduction

Dentigerous cysts are the second most common form of benign odontogenic cysts. These cysts are commonly single lesions. Bilateral and multiple dentigerous cysts are very rare.

Case presentation

This article presents a rare case report of bilateral dentigerous cysts associated with two ectopic teeth located atypically in the maxillary sinuses in a 19-year-old male manifesting as bilateral upper jaw pain, post-nasal discharge and recurrent sinusitis which was managed via the endonasal endoscopic approach by enucleation of the cysts and teeth removal.

Conclusion

This paper presented our experience in the management of a rare case of bilateral dentigerous cysts associated with ectopic teeth in the maxillary sinuses. Ct scan of the paranasal sinuses confirmed the diagnosis and the endonasal endoscopic approach is superior to the external approaches in preserving physiological function in managing these patients.

Removal of Infected Maxillary Third Molar from the Infra-temporal Fossa by Caldwell Luc Procedure - Rare Case Report with Literature Review

Dentigerous or follicular cysts of odontogenic origin are innocuous benign cysts that are often linked with the crowns of permanent teeth. A dentigerous cyst circumventing permanent teeth fails to erupt and is often displaced into ectopic positions in the upper and lower jaw in the maxillofacial region. In the maxilla or upper jaw region, the impacted teeth are often displaced and/or shift into the maxillary sinus and apart from the nasal septum, mandibular condyle, coronoid process and the palate, to harbour such ectopic eruptions of teeth. We report a rare case of an impacted left third molar of maxilla, associated with dentigerous cyst. The impacted tooth was embedded in the anterosuperior part of the infratemporal space. The cyst along with the tooth was removed using a modified Caldwell Luc incision.

Unusual Case of Sinusitis Related to Ectopic Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report

This article presents a case report of an adult patient with chronic sinusitis related to the presence of two erupted ectopic teeth located atypically in the maxillary sinus roof/orbital floor after a long latency period associated with childhood facial trauma. This article aims to show the treatment of chronic sinusitis of odontogenic origin by surgical removal of ectopic teeth in an unusual position by direct visualization. This case report discusses the signs and symptoms of chronic sinusitis linked to the presence of ectopic elements and associated with an inflammatory cyst, the choice of complementary tests for diagnosis and surgical treatment through the Caldwell-Luc procedure. After a 2-year follow-up period, the patient presently shows clinical improvement, thus demonstrating the success of the chosen treatment.

Ectopic 3rd molar tooth in the maxillary antrum

Location of ectopic tooth in a nondentate area like the maxillary antrum is rare. A 17-year-old boy, with one year history of recurrent right facial swelling and radiographic finding of a maxillary third molar tooth located at the posterior wall of the maxillary antrum, is presented. Under endotracheal intubation, the tooth was extracted through a Caldwell-Luc antrostomy approach and patient had an uneventful recovery and has been symptom free for eight months. Ectopic tooth in the maxillary antrum is rare and is commonest with maxillary third molar. It may be symptomless but is more commonly associated with inflammatory symptoms. The treatment of choice is surgical excision which is mostly carried out with Caldwell-Luc approach, even though endoscopic approach is being reported.

Facial Pain Associated with CPAP Use: Intra-Sinusal Third Molar

Objective. This paper describes a patient with left hemifacial pain elicited by the use of a CPAP mask. Case Report. A 74-year-old man was referred with a history of pain in the left maxillary sinus related to the use of his CPAP interface, thereby prohibiting the use of the latter. Computed tomography revealed an intra-sinusal ectopic third molar in the left maxillary sinus floor corresponding to the painful area. After removal of the ectopic tooth under local anesthesia by a Caldwell-Luc approach, the patient was relieved of his symptoms. Conclusion. Although an ectopic tooth in the maxillary sinus is rare, this case points out the importance of actively looking for a regional problem if patients cannot tolerate the CPAP interface since this can lead to issues of incompliance and medical complications due to the untreated obstructive sleep apnoea syndrome.

Anomalous morphology of an ectopic tooth in the maxillary sinus on three-dimensional computed tomography images

We describe a case of an incidentally-diagnosed ectopic tooth showing anomalous morphology in the maxillary antrum, using three-dimensional reconstruction of computed tomography images of the tooth obtained by multi-detector computed tomography.

Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A case report and review of literature

Dentigerous cysts are the most common type of developmental odontogenic cysts arising from the crowns of impacted, embedded, or unerupted teeth. They constitute about 20% of all epithelium-lined cysts of the jaws. The teeth involved most often are mandibular third molar and maxillary canines. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla. Dentigerous cysts associated with ectopic teeth within the maxillary sinus are fairly rare, and only 20 cases had been reported in Medline since 1980. In the present paper, we report an additional case of dentigerous cysts associated with ectopic third molar in the right maxillary sinus. Also, pathogenesis of ectopic tooth, role of advanced imaging, differential diagnosis, and management are discussed.

Tooth in oropharynx

The incidence of ectopic teeth has increased. In many cases, the etiology of ectopic teeth cannot be identified. Ectopic tooth in deciduous dentition period is very rare and information is limited about its causes and characteristics. The conditions commonly associated with an increased prevalence of ectopic teeth include cleft lip and palate, cleidocranial dysplasia, and Gardner syndrome. The diagnosis is made by the clinical and radiological examinations. The indication for extraction in ectopic teeth cases is in general determined by the presence of symptomatology, or by the need for preventing future complications. We present a case of an ectopic maxillary tooth in a 4 year-old boy. In addition, this report also addresses a young patient with a tooth in the oropharynx with the objective of non traumatic etiology, and such a clinical presentation is extremely rare. The authors believe the case presented here is the first documented case of an ectopic supernumerary tooth seen in the oropharynx.

Ectopic third molar in the maxillary sinus

Ectopic eruption of teeth into a region other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin and maxillary sinus. Occasionally, a tooth may erupt in the maxillary sinus and present with local sinonasal symptoms attributed to chronic sinusitis. We present a case of an ectopic maxillary third molar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus.

Ectopic mandibular third molar leading to osteomyelitis of condyle: a case report with literature review

BACKGROUND

A tooth is said to be ectopic if it is malpositioned either due to congenital factors or displaced due to pathological lesions. The incidence of osteomyelitis of condyle has a rare occurrence, very few cases have been reported, either their etiology is unknown or is due to hematogenous spread or a tuberculous focus. This particular case may be a rare of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle.

CASE REPORT

This report presents a unique case where an ectopically placed mandibular third molar led to extraoral sinus and scar formation below the ear lobule with osteomyelitis of the mandibular condyle and proposes various indications for its removal along with literature review.

DISCUSSION

Ectopic eruption of a tooth into the dental environment is common, whereas ectopic eruption of tooth in other sites is rare. The exact etiology of ectopic eruption of mandibular third molar in condyle is a rare occurrence and to the best of our knowledge, only 14 cases have been reported in the literature. Management of such cases should be meticulously planned after ruling out various local as well as systemic factors as an underlying cause for osteomyelitis and on the basis of the position and type of ectopic tooth and related potential trauma which could be caused by surgical intervention with less morbidity.

CONCLUSION

This particular case may be the unique of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. Diagnosis and management in such cases deserve very special attention to rule out various local and systemic causes which can cause osteomyelitis to affect very unusual site like mandibular condyle. The aim of surgical intervention should be to cause minimum morbidity without affecting the functional efficiency of the mandibular condyle. In this report, we also have proposed the indications for surgical intervention to remove ectopically erupted teeth.

Tooth in oropharynx

The incidence of ectopic teeth has increased. In many cases, the etiology of ectopic teeth cannot be identified. Ectopic tooth in deciduous dentition period is very rare and information is limited about its causes and characteristics. The conditions commonly associated with an increased prevalence of ectopic teeth include cleft lip and palate, cleidocranial dysplasia, and Gardner syndrome. The diagnosis is made by the clinical and radiological examinations. The indication for extraction in ectopic teeth cases is in general determined by the presence of symptomatology, or by the need for preventing future complications. We present a case of an ectopic maxillary tooth in a 4 year-old boy. In addition, this report also addresses a young patient with a tooth in the oropharynx with the objective of non traumatic etiology, and such a clinical presentation is extremely rare. The authors believe the case presented here is the first documented case of an ectopic supernumerary tooth seen in the oropharynx.

Ectopic canine associated with a dentigerous cyst in the maxilla

Ectopic eruption of a tooth is common in the dental arch, palate, and nose, but it is rare in the maxillary antrum. We present the case of a 35-year-old man with an ectopic canine and an associated dentigerous cyst in the maxillary sinus that masqueraded as an antrochoanal polyp.

Ectopic mandibular third molar in subcondylar region: report of a rare case

BACKGROUND

A tooth is ectopic if it is malpositioned due to congenital factors or displaced by the presence of pathology. Recent literature review suggests only 14 cases of ectopic mandibular third molar in the condylar region. Most have been treated using an extra-oral or endoscopic approach. Patients with an ectopic tooth impaction can remain asymptomatic over the course of their lifetime. But when such a tooth is accompanied by a cyst, patients can experience significant morbidity and require intervention.

CASE REPORT

This report presents a case of ectopic mandibular third molar in the left subcondylar region associated with pain and trismus.

DISCUSSION

Ectopic eruption of teeth is rare and reported in the mandibular condyle, coronoid process, orbit, palate, nasal cavity, nasal septum, chin and the maxillary antrum. Management of such cases should be meticulously planned on the basis of the position and type of the ectopic tooth and related potential trauma which could be caused by surgical intervention.

Ectopic mandibular third molar in subcondylar region: report of a rare case

BACKGROUND

A tooth is ectopic if it is malpositioned due to congenital factors or displaced by the presence of pathology. Recent literature review suggests only 14 cases of ectopic mandibular third molar in the condylar region. Most have been treated using an extra-oral or endoscopic approach. Patients with an ectopic tooth impaction can remain asymptomatic over the course of their lifetime. But when such a tooth is accompanied by a cyst, patients can experience significant morbidity and require intervention.

CASE REPORT

This report presents a case of ectopic mandibular third molar in the left subcondylar region associated with pain and trismus.

DISCUSSION

Ectopic eruption of teeth is rare and reported in the mandibular condyle, coronoid process, orbit, palate, nasal cavity, nasal septum, chin and the maxillary antrum. Management of such cases should be meticulously planned on the basis of the position and type of the ectopic tooth and related potential trauma which could be caused by surgical intervention.

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis

Background

Ectopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a patient who initially presented with haemoptysis.

Case presentation

A 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. Although the patient was empirically started on antibiotic and anti-allergic therapy, there was no improvement after a few weeks and the patient had recurrent episodes of haemoptysis. Fibre-optic visualization was repeated showing bilateral osteomeatal erythema. Computed tomography scan of the paranasal sinuses demonstrated complete opacification of the left maxillary antrum along with a focal area of density comparable to bone. An ectopic, supernumerary molar tooth was found in the left maxillary antrum on endoscopic examination and subsequently removed. In addition, copious purulent discharge was seen. Post-operatively, the patient was treated with a 10-day course of oral amoxicillin-clavulanate. On follow-up, he reported resolution of symptoms.

Conclusion

Recurrent haemoptysis has not been described as a presentation for a supernumerary, ectopic tooth in literature before. We recommend that in patients with sinusitis-type of opacification of maxillary antrum and whose condition is refractory to conventional medical treatment, consideration should be given to the investigation of possible underlying anomalies as the cause of such symptoms. Presence of foreign bodies and ectopic teeth in paranasal sinuses can be reliably excluded with the use of appropriate radiological imaging and endoscopic examination.

A rare cause of nasolacrimal duct obstruction: dentigerous cyst in the maxillary sinus

The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. Dentigerous cysts surrounding impacted teeth often displace teeth into ectopic positions. In the maxilla, these teeth are often displaced into the maxillary sinus. We report 3 cases of dentigerous cysts associated with an ectopic tooth in the maxillary sinus and review the literature reports of this condition over the past 29 years.

A dentigerous cyst containing an ectopic canine tooth below the floor of the maxillary sinus: a case report

Ectopic eruption into the dental environment is common, whereas eruption into other sites is rare. Diverse anatomical locations such as the mandibular condyle, coronoid process, palate, maxillary sinuses and nasal cavity can infrequently be the site of ectopic tooth eruption. One of the nondental sites for ectopic eruption is the maxillary sinus. Here, we present a case of dentigerous cyst with an ectopic maxillary canine tooth located below the floor of the right maxillary sinus in a 37-year-old man.

Frontal mucocele caused by an ectopic maxillary tooth

OBJECTIVE

To present a previously unreported cause of frontal mucocele.

CASE REPORT

A patient presented with a frontal mucocele and maxillary sinusitis. Computed tomography revealed an ectopic maxillary tooth as the cause of her signs and symptoms. Removal of the tooth by a Caldwell-Luc procedure facilitated resolution of the mucocele. Conventional treatment of mucoceles by endoscopic sinus surgery, and other rhinological sequelae of ectopic teeth, are considered.

CONCLUSION

This is the first documented case of an ectopic tooth causing a frontal mucocele, and demonstrates how effectively the patient's symptoms resolved on removal of the tooth.

Endoscopic Removal of a Dentigerous Cyst Producing Unilateral Maxillary Sinus Opacification on Computed Tomography

We report the case of a 14-year-old girl who was referred to us with a 2-year history of abnormal panoramic dental x-rays. Computed tomography of the paranasal sinuses demonstrated a left unilateral maxillary sinus opacification that had been produced by an ectopic molar. The tooth was removed via an endoscopic approach rather than with a traditional Caldwell-Luc procedure. A nasal endoscope was used to create a middle meatal antrostomy and deliver the tooth and its cystic contents. The patient recovered without complications, and she exhibited no signs of recurrence at the 2-year follow-up.

Clinical impact of ectopic teeth in the maxillary sinus

OBJECTIVE

To evaluate the clinical features, aetiologic factors, challenging properties (such as radio opacity in Water's view in a patient with no sinusitis), signs and symptoms of the ectopic teeth in the maxillary sinus.

STUDY DESIGN

Clinical symptoms and radiographic findings of 14 patients with ectopic teeth in the maxillary sinus were evaluated. Computed tomography (CT) and conventional radiographic images of maxillary sinus and clinical findings were compared with each other with regard to the final diagnosis.

RESULTS

Water's view is inadequate to diagnose ectopic tooth in the maxillary sinus in some cases. Panoramic radiographs may be preferred before CT to evaluate the ectopic tooth in the maxillary sinus as structure of a tooth can be clearly detected on panoramic radiographs. Crowding was the most common aetiologic factor among the 14 cases.

CONCLUSION AND SIGNIFICANCE

The patients with ectopic tooth in the maxillary sinus should be evaluated thoroughly by complete otorhinolaryngologic, intraoral examinations and proper diagnostic imaging procedures in order to avoid misdiagnosis of maxillary sinusitis. As the opacity of the maxillary sinus in Water's view due to ectopic tooth can be misinterpreted as maxillary sinusitis, patients who have sinusitis-like complaints and opacity of maxillary sinus in Water's view who are resistant to medical treatment should be evaluated with respect to the presence of ectopic tooth.

Endoscopic Removal of an Ectopic Third Molar Obstructing the Osteomeatal Complex

We report a rare case of an ectopic third molar at the level of the osteomeatal complex. A 21-year-old man came to us with a left-sided nasal obstruction of 2 years’ duration. Computed tomography of the paranasal sinuses revealed that an aberrant tooth was obstructing the osteomeatal complex and bulging into the ethmoid infundibulum. Opacity of the entire left maxillary sinus indicated the presence of an associated cystic formation. A transnasal endoscopic sinus technique was employed to create a large middle meatal antrostomy and to remove the tooth as well as the cystic contents and cyst wall. Pathologic analysis revealed that the cyst was dentigerous. After recovery from surgery, the patient resumed nasal breathing. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods (e.g., the Caldwell-Luc procedure) of removing ectopic teeth from the sinus.

Nasolacrimal duct obstruction secondary to ectopic teeth

OBJECTIVE

To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed.

DESIGN

Two interventional case reports and literature review.

PARTICIPANTS

A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative.

INTERVENTION

A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed.

MAIN OUTCOME MEASURES

Nasolacrimal system function and response to treatment at the last follow-up were recorded.

RESULTS

In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up.

CONCLUSIONS

These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction.